Validation and clinical interpretation of the St George's Respiratory Questionnaire among COPD patients, China

SETTING

Although the St George's Respiratory Questionnaires in Mandarin-Chinese (SGRQ-MC) have been used in China, few data are available on the translation and adaptation process, psychometric properties and clinical meaning. It is therefore difficult to adequately evaluate the equivalence of this instrument in Chinese populations.

OBJECTIVE

To evaluate the psychometric properties of a culturally translated SGRQ-MC, and to estimate clinically important differences (CID) for the SGRQ in chronic obstructive pulmonary disease (COPD) patients in China.

DESIGN

SGRQ was translated into Mandarin using standardised forward and backward translation procedures. Health status and clinical data were collected at baseline in 491 patients with stable COPD and again after 1 week in 131 randomly selected patients. All patients were followed up monthly and assessed during exacerbations and at 1 year.

RESULTS

The SGRQ-MC showed good internal consistency, test-retest reliability, convergent validity and known-group validity. Responsiveness was shown by significant changes in SGRQ-MC scores between stable stage and exacerbation (P<0.0001). The estimated CID for the total score ranged from 3.1 (95%CI -0.3-6.5) to 7.7 (95%CI -1.7-17.2).

CONCLUSION

This SGRQ-MC is a reliable, valid and responsive instrument for quality of life evaluation in COPD patients in China. As it is culturally and clinically equivalent to other versions, measures can be compared among countries.

Luminal group may give more benefit for invasive micropapillary carcinoma component breast cancer patients: experience from Cancer Hospital Fudan University

Abstract #6152

Objective: Comparative studies on clinical features and outcomes of very rare invasive micropapillary carcinoma of breast cancer of 4 subtypes by immunohistochemistry staining.&#x2028; Methods: From Aug 2005 to Mar 2008, a total of 52 breast cancer patients(BCPs) with an invasive micropapillary component (IMPC) among 1951 Chinese BCPs with complete of clinicopathologic data in our institution were enrolled into a retrospective analysis. We characterized all these 52 patients and analyzed using various parameters.&#x2028; Results: The 52 cases of breast carcinoma with an IMPC all occurred in women. Mean age was 51 years (range from 26-82). All of these patients had breast masses; one also had metastasis to the supraclavicular lymph node at the time of diagnosis., mean tumor size was 2.83cm(T2), 23.08%(12/52) was pure invasive micropapillary carcinoma, and lymph node positive percentage was 75.59 %( 36/51).Fifty one patients received surgery, while one of them lost the chance of surgery. Forty of them received the modified mastectomy while one was performed lumpectomy due to old age. One was performed LAND alone and four were performed lumpectomy and sentinel lymph node biopsy.&#x2028; By using IHC staining, when we regard HER2/neu 0 and +as negative. The Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 76.92% (40/52), 11.54 %( 6/52), 7.69 %( 4/52), 3.85 %( 2/52), respectively. Compared to the database of 2005 breast cancer carcinoma in our institution, there was more Luminal A group patients than the whole group (P=0.01, chi-square test.), more Luminal B (P=0.028, Fisher exact possibility test), less trip-negative group (P=0.001, chi-square test). The positive lymph node among the Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 65%,80%, 100%, 100%, respectively, while the lymphvascular invasion were 55%,33.33%,50%,50%,respectively, Mulifocality in Luminal A was 25% , 16.67% in Luminal B , while 50% in both trip-negative and HER2+/ER-.&#x2028; Twenty-one of them received both anthracyclines and Taxane, while 27 only received anthracyclines, Four patients only were received only AIs due to old age. All the luminal group patients received endrocine therapy after chemo. After nearly 14 months (2∼34 months) follow up, thirty-six women were disease free, one had local recurrence, and 1 had lung metastasis, while 1 had ovary carcinoma when the diagnosis of breast malignant, one patient lost following up due to mental disorder. Among the luminal B, one had metastasis when diagnosis, others were disease free. One woman of the trip-negative died of non-breast cancer disease,the HER2+/ER- group was no recurrence or metastasis.&#x2028; Discussion: The prelimary results showed that more luminal group in the IMPC may get benefit from the endocrine therapy. However the number of these cases is small and follow-up time is not very long, further studies are necessary to explain these rare and unique pattern of invasive carcinoma.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6152.

Seroma formation after breast cancer surgery and its risk factors

Abstract #4085

Background:. Seroma formation is one of the most common complications after breast cancer surgery including modified radical mastectomy and breast conservative surgery. Our study aims to investigate the risk factors of postoperative seroma in Chinese breast cancer patients.&#x2028; Methods: Clinical data of 158 women who underwent surgerical therapy for breast cancer in our hospital were collected prospectively and all patients were followed up. The risk factors for seroma occurrence were compared between the seroma group and control group using X 2 test or t test, as well as the logistic regression was used as multivariate analysis.&#x2028; Results: Univariate analysis showed that the average age of the seroma group was significantly higher than those without seroma formation(58.71vs51.00, P=0.0019), but the total serum protein and albumin content were lower (68.47g/L vs 72.53g/L, P=0.009 and 40.75g/L vs 42.52g/L,P=0.020, respectively). In seroma group, the drainage volume of the first three days, the total and daily drainage volume were all higher (all p values less than 0.01), as well as drainage duration and hospital stay were longer(8.3d vs 14.4d, P=0.000 and 11.5d vs 23.7d, P=0.000, respectively). Logistic regression showed that older patients (OR=1.080, 95%CI 1.016∼1.148, P=0.013), lower total serum protein content(OR=0.814, 95%CI 0.705∼0.940, P=0.005)and higher drainage volume in d1(OR=1.009, 95%CI 1.001∼1.016, P=0.022) and d3 (OR=1.017, 95%CI 1.005∼1.029, P=0.005) were all independent risk factors for subcutaneous seroma. The daily average drainage curve showed a gradually decreasing trend with a highest collections in the first three days. The seroma group had significantly higher average daily drainage volume( P=0.034) and longer duration (P=0.000).&#x2028; Conclusion:The risk factors of seroma formation after breast cancer surgery are complicated. However in order to prevent its occurrence effectively, the factors including age, nutrition status and daily drainage volume should be taken into consideration.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4085.

Clinicopathological features of the triple-negative tumors in Chinese breast cancer patients

Abstract #6080

Background: Triple negative breast cancers are defined by a lack of expression of estrogen, progesterone, and Her-2 receptors. A number of studies suggested that the triple-negative phenotype could contribute to an aggressive behavior and a poor prognosis. However, similar data is still not available for Chinese populations. We sought to analyze the clinicopathological features of this subgroup in our hospital in order to get characteristics for Chinese breast cancer.&#x2028; Methods: We performed a retrospective study of 2028 female unilateral breast cancer patients undergoing surgery in our hospital from February 1991 to December 2003. ER, PR and Her-2 status were assessed using immunohistochemical staining. Survival curves were performed with Kaplan-Meier method and annual recurrence hazard was estimated by hazard function.&#x2028; Results: According to different combinations of hormone receptor (HR) and Her-2 status, 2028 patients were categorized into the three subgroups as follows: Her-2+ (32.25%), HR+/Her-2- (48.92%) and triple-negative (18.83%). Triple-negative tumors were larger (greater than 2 cm in diameter) than HR+/Her-2- tumors, but smaller than Her-2+ tumors (70.03%, 66.15% and 76.15% respectively, P &lt; 0.001). In addition, 21.99% of patients whose tumors were triple-negative had four or more axillary nodes involved compared with 27.37% of patients with Her-2+ tumors and 22.78% with HR+/Her-2- tumors (P = 0.004). There were statistical differences in the distribution of TP53 mutation and Cathepsin-D status (P &lt; 0.001 for both). In the univariate analysis, we found a statistical significance for recurrence-free survival (RFS) among the three subgroups (P = 0.0036), with the rate of 72.89% for Her-2+ tumors, 78.26% for HR+/Her-2- tumors and 75.61% for triple-negative tumors at the 11th year respectively. When it came to the time of hazard peaks, discrepancies existed in different subgroups. Triple-negative patients showed an early major recurrence surge peaking at the 2.5th year after surgery, followed by a gradual decline until year 6.5 and then a modest increase. As to HR+/Her-2- patients, the hazard plot exhibited a wide initial plateau-like wave covering at least 4 years and a subsequent rise. The hazard rate for Her-2+ patients displayed a tapering sharp at the 1st year and a second rise. Furthermore, the first peak of triple-negative tumors was higher than that of HR+/Her-2- patients, but lower than that of Her-2+ ones.&#x2028; Conclusions: The recurrence pattern for triple-negative tumors was intermediate between Her-2+ and HR+/Her-2- counterparts.Our findings suggested that biological characteristics and prognosis of Chinese triple-negative breast cancer might be more favorable and somewhat different from those in Western populations.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6080.

Circulating tumor cell and endothelial cell data from a phase II evaluation of lapatinib and bevacizumab in HER2-overexpressing metastatic breast cancer

Abstract #3154

Background: Overexpression of both HER2 and VEGF is associated with worse outcome than overexpression of either receptor alone. In preclinical models, combination anti-HER2 and anti-VEGF therapy has been shown to be more effective than either treatment alone. Bevacizumab (B) plus trastuzumab and lapatinib (L) plus pazopanib have shown activity in patients (pts) with HER2+ MBC. We evaluated the combination of L+B in a phase 2 trial in HER2+ MBC pts. To explore new biomarkers of treatment effect, we measured circulating tumor cells (CTCs) with two different methods of CTC enumeration: CellSearch (Veridex LLC), and immunomagnetic enrichment followed by flow cytometry (IE/FC), as well as circulating endothelial cells (CECs) in pts receiving study treatment.&#x2028; Methods: This study evaluated L (1500 mg PO daily) plus B (10 mg/kg IV q2wk) in 50 HER2+ MBC pts. The primary endpoint is crude progression-free survival (PFS) at 12 wks. Serial evaluation of CTC and CEC was performed. Blood was obtained from consenting pts at baseline, weeks 2, 6 then every 12 weeks until end of study. CellSearch assay was performed as previously described using 7.5 cc blood in a CellSave tube and the CellSpotter analyzer. For IE/FC, 20 ml of blood was subjected to IE using anti-EpCAM ferrofluid, followed by FC for EpCAM, CD45, and nucleic acid content. CTC data were correlated with assay method and with best response. CECs were defined as CD34/31+, CD45-, or CD34/146+, CD45-, and were assayed by FC.&#x2028; Results: Enrollment to this study ended in March 2008 (n=52). Clinical data is presented at this meeting (Dickler et al). 47 patients have evaluable CTC and CEC data at baseline and/or first follow-up; 32 patients have response data. CTC determined by CellSearch or IE/FC showed significant correlation at baseline (R=0.58; P=0.012). CTC by CellSearch at first followup correlated with treatment response (P=0.01) with levels above 5 CTC/sample associated with progression; there was no correlation with baseline values. There were too few positive IE/FC values to evaluate correlation with outcome. The change in CEC/CD146 from baseline to first followup for is of borderline significance in this preliminary analysis (P=0.07) between PR (N=2, Mean Change Score/MCS=-4.345) and SD/PD (N=18, MCS=0.8); a decrease of CEC/CD146 from baseline to first followup suggests greater likelihood of response.&#x2028; Conclusions: L+B is an active regimen in pts with MBC. CTC measurements correlated between two separate methodologies, and for the CellSearch assay predicted response to therapy. A decrease in CEC from baseline to first followup correlated with response to this combined targeted therapy, consistent with our previous results with other B-based therapy. PFS and response correlations for the full study cohort will be presented.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3154.

Observation of ion-cyclotron-frequency mode-conversion flow drive in tokamak plasmas

Strong toroidal flow (Vphi) and poloidal flow (Vtheta) have been observed in D-3He plasmas with ion cyclotron range of frequencies (ICRF) mode-conversion (MC) heating on the Alcator C-Mod tokamak. The toroidal flow scales with the rf power Prf (up to 30 km/s per MW), and is significantly larger than that in ICRF minority heated plasmas at the same rf power or stored energy. The central Vphi responds to Prf faster than the outer regions, and the Vphi(r) profile is broadly peaked for r/a < or =0.5. Localized (0.3 < or = r/a < or =0.5) Vtheta appears when Prf > or =1.5 MW and increases with power (up to 0.7 km/s per MW). The experimental evidence together with numerical wave modeling suggests a local flow drive source due to the interaction between the MC ion cyclotron wave and 3He ions.

Cloning, sequence analysis, and expression of cDNA coding for the major house dust mite allergen, Der f 1, in Escherichia coli

Our objective was to clone, express and characterize adult Dermatophagoides farinae group 1 (Der f 1) allergens to further produce recombinant allergens for future clinical applications in order to eliminate side reactions from crude extracts of mites. Based on GenBank data, we designed primers and amplified the cDNA fragment coding for Der f 1 by nested-PCR. After purification and recovery, the cDNA fragment was cloned into the pMD19-T vector. The fragment was then sequenced, subcloned into the plasmid pET28a(+), expressed in Escherichia coli BL21 and identified by Western blotting. The cDNA coding for Der f 1 was cloned, sequenced and expressed successfully. Sequence analysis showed the presence of an open reading frame containing 966 bp that encodes a protein of 321 amino acids. Interestingly, homology analysis showed that the Der p 1 shared more than 87% identity in amino acid sequence with Eur m 1 but only 80% with Der f 1. Furthermore, phylogenetic analyses suggested that D. pteronyssinus was evolutionarily closer to Euroglyphus maynei than to D. farinae, even though D. pteronyssinus and D. farinae belong to the same Dermatophagoides genus. A total of three cysteine peptidase active sites were found in the predicted amino acid sequence, including 127-138 (QGGCGSCWAFSG), 267-277 (NYHAVNIVGYG) and 284-303 (YWIVRNSWDTTWGDSGYGYF). Moreover, secondary structure analysis revealed that Der f 1 contained an a helix (33.96%), an extended strand (17.13%), a ss turn (5.61%), and a random coil (43.30%). A simple three-dimensional model of this protein was constructed using a Swiss-model server. The cDNA coding for Der f 1 was cloned, sequenced and expressed successfully. Alignment and phylogenetic analysis suggests that D. pteronyssinus is evolutionarily more similar to E. maynei than to D. farinae.

Scrape-off layer reflectometer for Alcator C-Mod

A two-frequency x-mode reflectometer operating from 100 to 146 GHz is deployed on Alcator C-Mod to measure the density profile and fluctuations in the scrape-off layer (SOL) immediately in front of the new J-port ICRF antenna and the new C-port lower hybrid launcher. The reflectometer covers densities from 10(16) to 10(20) m(-3) at 5-5.4 T. To provide the greatest flexibility and capability to deal with density fluctuations approaching 100% peak-to-peak in the SOL, both full-phase and differential-phase measurement capabilities with sweep speeds of approximately 10 micros to >1 ms are implemented. The differential-phase measurement uses a difference frequency of 500 MHz, corresponding to cutoff layer separations ranging from about 0.1 to 1 mm. The reflectometer has six sets of launchers: three on the ICRF antenna and three on the lower hybrid launcher. Both the ICRF antenna and the lower hybrid launcher incorporate reflectometer antennas at their top, bottom, and midplane locations.

CART peptides: regulators of body weight, reward and other functions

Over the past decade or so, CART (cocaine- and amphetamine-regulated transcript) peptides have emerged as major neurotransmitters and hormones. CART peptides are widely distributed in the CNS and are involved in regulating many processes, including food intake and the maintenance of body weight, reward and endocrine functions. Recent studies have produced a wealth of information about the location, regulation, processing and functions of CART peptides, but additional studies aimed at elucidating the physiological effects of the peptides and at characterizing the CART receptor(s) are needed to take advantage of possible therapeutic applications.

Preliminary study of hemodynamic distribution in patient-specific stenotic carotid bifurcation by image-based computational fluid dynamics

BACKGROUND

Regions prone to atherosclerosis, such as bends and bifurcations, tend to exhibit a certain degree of non-planarity or curvature, and these geometric features are known to strongly influence local flow patterns. Recently, computational fluid dynamics (CFD) has been used as a means of enhancing understanding of the mechanisms involved in atherosclerotic plaque formation and development.

PURPOSE

To analyze flow patterns and hemodynamic distribution in stenotic carotid bifurcation in vivo by combining CFD with magnetic resonance angiography (MRA).

MATERIAL AND METHODS

Twenty-one patients with carotid atherosclerosis proved by digital subtraction angiography (DSA) and/or Doppler ultrasound underwent contrast-enhanced MR angiography of the carotid bifurcation by a 3.0T MR scanner. Hemodynamic variables and flow patterns of the carotid bifurcation were calculated and visualized by combining vascular imaging postprocessing with CFD.

RESULTS

In mild stenotic cases, there was much more streamlined flow in the bulbs, with reduced or disappeared areas of weakly turbulent flow. Also, the corresponding areas of low wall shear stress (WSS) were reduced or even disappeared. As the extent of stenosis increased, stronger blood jets formed at the portion of narrowing, and more prominent eddy flows and slow back flows were noted in the lee of the stenosis. Regions of elevated WSS were predicted at the portion of stenosis and in the path of the downstream jet. Areas of low WSS were predicted on the leeward side of the stenosis, corresponding with the location of slowly turbulent flows.

CONCLUSION

CFD combined with MRA can simulate flow patterns and calculate hemodynamic variables in stenotic carotid bifurcations as well as normal ones. It provides a new method to investigate the relationship of vascular geometry and flow condition with atherosclerotic pathological changes.

Assessment of wall shear stress in the common carotid artery of healthy subjects using 3.0-tesla magnetic resonance

BACKGROUND

Wall shear stress (WSS) has been proven to play a critical role in the formation and development of atherosclerotic plaques. Measurement of WSS in vivo is significant for the clinical assessment of atherosclerosis.

PURPOSE

To assess the magnitude and distribution of local WSS in the common carotid artery (CCA) in vivo using 3.0T magnetic resonance (MR).

MATERIAL AND METHODS

The common carotid artery of eight healthy volunteers was studied using a cine phase-contrast MR sequence. A three-dimensional paraboloid model was applied to fit the velocity profiles, and the WSS values were calculated. The cross-sectional area, average flow velocity, maximum velocity, and flow rate were also obtained.

RESULTS

Mean WSS was 0.850 +/- 0.195 (range 0.132-3.464) N/m(2) for the common carotid arteries; the spatial and temporal distribution and change of WSS were displayed. During a cardiac cycle, the mean velocity was 22.8 +/- 3.5 (16.9-28.3) cm/s, blood flow rate 8.03+/-1.45 (5.73-10.72) ml/s, and luminal vessel area 34.94+/-7.06 (24.25-49.01) mm(2).

CONCLUSION

Local WSS values in CCAs can be measured using 3.0T MR imaging combined with image-processing techniques. Intersubject variations were found in the distribution and magnitude of wall shear stress as well as in the flow profile pattern in CCAs, which may be caused by different vessel morphologies.

Quantification of brain creatine concentration using PRESS sequence and LCModel: comparison with HPLC method

To investigate the accuracy for quantification of brain total creatine (Cr) concentration using in vivo long echo time (TE) PRESS sequence with an external standard and LCModel. Ten swine and an external standard containing a detectable compounds of known concentration were studied by using 1.5 T GE Signa scanner and the standard head coil; the single-voxel proton magnetic resonance spectroscopy (1H-MRS) data was acquired from the 20-mm cubic VOI which was placed in the swine brain and external standard respectively by using the PRESS sequence with TE=135 msec, TR=1500 msec, and 128 scan averages. The quantification of Cr was accomplished by the linear combination of model spectra (LCModel). After MRS examination, each animal was sacrificed, and in vitro Cr concentration was analyzed by high performance liquid chromatography (HPLC). In the MRS group, the mean concentration of Cr was 9.37+/-0.137mmol/kg; in the HPLC group, the mean concentration of Cr was 8.905+/-0.126 mmol/kg. There were no statistically significant differences between two methods (P=0.491), which indicated that long TE PRESS sequence with an external standard can accurately detect the brain Cr concentration. The application of LCModel introduces more convenience for the MRS quantification.

Diet-induced central obesity and insulin resistance in rabbits

The present study was designed to examine whether rabbits fed a diet containing high fat and sucrose could develop obesity and insulin resistance (IR), the major pathophysiological features of metabolic syndrome. Male Japanese white rabbits were fed either a normal chow diet (control) or high fat and sucrose diet (HFSD) for 36 weeks. Plasma levels of triglycerides (TG), total cholesterol (TC), glucose and insulin were measured. To evaluate glucose metabolism, we performed an intravenous glucose tolerance test. In addition, we compared adipose tissue accumulation in HFSD-fed rabbits with that in normal rabbits. HFSD constantly and significantly led to an increase in body weight of HFSD-fed rabbits, caused by significantly higher visceral adipose tissue accumulation. Although there were no differences in plasma TG, TC, glucose, insulin levels and blood pressure between the two groups, HFSD-fed rabbits showed impaired glucose clearance associated with higher levels of insulin secretion compared to control rabbits. Our results showed that HFSD induced IR and increased adipose accumulation in rabbits, suggesting that HFSD-fed rabbits may become a model for research on human IR and obesity.